Compression for preventing recurrence of venous ulcers

Background: Up to 1% of adults will suffer from leg ulceration at some time. The majority of leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or weakness of the valves in the veins of the leg. Prevention and treatment of venous ulcers is aimed at reducing the pressure either by removing / repairing the veins, or by applying compression bandages / stockings to reduce the pressure in the veins. The vast majority of venous ulcers are healed using compression bandages. Once healed they often recur and so it is customary to continue applying compression in the form of bandages, tights, stockings or socks in order to prevent recurrence. Compression bandages or hosiery (tights, stockings, socks) are often applied for ulcer prevention. Objectives To assess the effects of compression hosiery (socks, stockings, tights) or bandages in preventing the recurrence of venous ulcers. To determine whether there is an optimum pressure/type of compression to prevent recurrence of venous ulcers. Search methods The searches for the review were first undertaken in 2000. For this update we searched the Cochrane Wounds Group Specialised Register (October 2007), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2007 Issue 3, Ovid MEDLINE - 1950 to September Week 4 2007, Ovid EMBASE - 1980 to 2007 Week 40 and Ovid CINAHL - 1982 to October Week 1 2007. Selection criteria Randomised controlled trials evaluating compression bandages or hosiery for preventing venous leg ulcers. Data collection and analysis Data extraction and assessment of study quality were undertaken by two authors independently. Results No trials compared recurrence rates with and without compression. One trial (300 patients) compared high (UK Class 3) compression hosiery with moderate (UK Class 2) compression hosiery. A intention to treat analysis found no significant reduction in recurrence at five years follow up associated with high compression hosiery compared with moderate compression hosiery (relative risk of recurrence 0.82, 95% confidence interval 0.61 to 1.12). This analysis would tend to underestimate the effectiveness of the high compression hosiery because a significant proportion of people changed from high compression to medium compression hosiery. Compliance rates were significantly higher with medium compression than with high compression hosiery. One trial (166 patients) found no statistically significant difference in recurrence between two types of medium (UK Class 2) compression hosiery (relative risk of recurrence with Medi was 0.74, 95% confidence interval 0.45 to 1.2). Both trials reported that not wearing compression hosiery was strongly associated with ulcer recurrence and this is circumstantial evidence that compression reduces ulcer recurrence. No trials were found which evaluated compression bandages for preventing ulcer recurrence. Authors' conclusions No trials compared compression with vs no compression for prevention of ulcer recurrence. Not wearing compression was associated with recurrence in both studies identified in this review. This is circumstantial evidence of the benefit of compression in reducing recurrence. Recurrence rates may be lower in high compression hosiery than in medium compression hosiery and therefore patients should be offered the strongest compression with which they can comply. Further trials are needed to determine the effectiveness of hosiery prescribed in other settings, i.e. in the UK community, in countries other than the UK.

Design and evaluation of an MRI compatible axial compression device for 3D assessment of spinal deformity and flexibility in adolescent idiopathic scoliosis

Magnetic Resonance Imaging (MRI) offers a valuable research tool for the assessment of 3D spinal deformity in AIS, however the horizontal patient position imposed by conventional scanners removes the axial compressive loading on the spine. The objective of this study was to design, construct and test an MRI compatible compression device for research into the effect of axial loading on spinal deformity using supine MRI scans. The device was evaluated by performing unloaded and loaded supine MRI scans on a series of 10 AIS patients. The patient group had a mean initial (unloaded) major Cobb angle of 43±7º, which increased to 50±9º on application of the compressive load. The 7° increase in mean Cobb angle is consistent with that reported by a previous study comparing standing versus supine posture in scoliosis patients (Torell et al, 1985. Spine 10:425-7).

An environmental assessment model for knowledge-based urban development

Purpose – In recent years, knowledge-based urban development (KBUD) has introduced as a new strategic development approach for the regeneration of industrial cities. It aims to create a knowledge city consists of planning strategies, IT networks and infrastructures that achieved through supporting the continuous creation, sharing, evaluation, renewal and update of knowledge. Improving urban amenities and ecosystem services by creating sustainable urban environment is one of the fundamental components for KBUD. In this context, environmental assessment plays an important role in adjusting urban environment and economic development towards a sustainable way. The purpose of this paper is to present the role of assessment tools for environmental decision making process of knowledge cities. Design/methodology/approach – The paper proposes a new assessment tool to figure a template of a decision support system which will enable to evaluate the possible environmental impacts in an existing and future urban context. The paper presents the methodology of the proposed model named ‘ASSURE’ which consists of four main phases. Originality/value –The proposed model provides a useful guidance to evaluate the urban development and its environmental impacts to achieve sustainable knowledge-based urban futures. Practical implications – The proposed model will be an innovative approach to provide the resilience and function of urban natural systems secure against the environmental changes while maintaining the economic development of cities.

A dog of a QCAT : collateral effects of mandated English assessment in the Torres Strait

This paper critiques a 2008 Queensland Studies Authority (QSA) assessment initiative known as Queensland Comparable Assessment Tasks, or QCATs. The rhetoric is that these centrally devised assessment tasks will provide information about how well students can apply what they know, understand and can do in different contexts (QSA, 2009). The QCATs are described as ‘authentic, performance-based assessment’ that involves a ‘meaningful problem’, ‘emphasises critical thinking and reasoning’ and ‘provides students with every opportunity to do their best work’ (QSA, 2009). From my viewpoint as a teacher, I detail my professional concerns with implementing the 2008 middle primary English QCAT in one case study Torres Strait Island community. Specifically I ask ‘QCATs: Comparable with what?’ and ‘QCATs: Whose authentic assessment?’. I predict the possible collateral effects of implementing this English assessment in this remote Indigenous community, concluding, rather than being an example of quality assessment, colloquially speaking, it is nothing more than a ‘dog’.

Social studies disciplinary knowledge: Tensions between state curriculum and national assessment requirements

In this chapter, we are particularly concerned with making visible the general principles underlying the transmission of Social Studies curriculum knowledge, and considering it in light of a high-stakes mandated national assessment task. Specifically, we draw on Bernstein’s theoretical concept of pedagogic models as a tool for analysing orientations to teaching and learning. We introduce a case in point from the Australian context: one state Social Studies curriculum vis-a-vis one part of the Year Three national assessment measure for reading. We use our findings to consider the implications for the disciplinary knowledge of Social Studies in the communities in which we are undertaking our respective Australian Research Council Linkage project work (Glasswell et al.; Woods et al.). We propose that Social Studies disciplinary knowledge is being constituted, in part, through power struggles between different agencies responsible for the production and relay of official forms of state curriculum and national literacy assessment. This is particularly the case when assessment instruments are used to compare and contrast school results in highly visible web based league tables (see, for example, http://myschoolaustralia.ning.com/).

Structural health monitoring : vibration-based damage detection and condition assessment of bridges

Structural health is a vital aspect of infrastructure sustainability. As a part of a vital infrastructure and transportation network, bridge structures must function safely at all times. However, due to heavier and faster moving vehicular loads and function adjustment, such as Busway accommodation, many bridges are now operating at an overload beyond their design capacity. Additionally, the huge renovation and replacement costs are a difficult burden for infrastructure owners. The structural health monitoring (SHM) systems proposed recently are incorporated with vibration-based damage detection techniques, statistical methods and signal processing techniques and have been regarded as efficient and economical ways to assess bridge condition and foresee probable costly failures. In this chapter, the recent developments in damage detection and condition assessment techniques based on vibration-based damage detection and statistical methods are reviewed. The vibration-based damage detection methods based on changes in natural frequencies, curvature or strain modes, modal strain energy, dynamic flexibility, artificial neural networks, before and after damage, and other signal processing methods such as Wavelet techniques, empirical mode decomposition and Hilbert spectrum methods are discussed in this chapter.